Twins for a 70-year-old? Louise Brown's doctors didn't envision this

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Omkari Panwar underwent in vitro fertilization to give birth to twins this month at age 70. With two daughters and five granddaughters, she and her husband, Charam Singh, who's in his mid-70s, wanted a boy.

Omkari Panwar has given new meaning to the idea that 70 is the new 60. Or perhaps 70 is the new 30?

Earlier this month, the 70-year-old mother of two daughters and grandmother to five gave birth via Cesarean section to twins, a boy and girl, at a hospital in India’s Uttar Pradesh state after undergoing infertility treatment. If her age can be verified — she has no birth certificate — she would become the oldest woman ever to give birth.

This startling birth raises all sorts of ethical questions, particularly whether a 70-year-old should be accepted as a patient by any infertility program. But there is yet another twist to this birth. It comes almost exactly 30 years after a woman named Lesley Brown gave birth, also via C-section, in a hospital near Manchester, England. Brown was the mother of the very first baby created by in vitro fertilization, the very technique used in the Indian septuagenarian birth.

Lesley Brown, who was 30 years old at the time, had tried for many years to have a baby with her husband, John. She went to doctors to find out why she couldn’t conceive and eventually made her way to Dr. Patrick Steptoe and Robert Edwards, who were pioneering the emerging field of infertility medicine. They determined that her Fallopian tubes were blocked. While she could make eggs, her husband’s sperm could not reach them. They reasoned that if they could get one or more eggs from her ovary, fertilize them with sperm from her husband in a dish, and then put back any embryos that were created, they should grow without any difficult in Lesley’s own healthy uterus. They were right. Louise Joy Brown, born on July 25, 1978, became the world’s first “test-tube” baby.

'Test-tube' baby raised ethical concerns
At the time, Steptoe and Edwards’ plan to make a baby using conception outside the human body was the subject of a huge amount of ethical criticism. Some maintained that creating children this way was simply unnatural and would stigmatize the child. Others bemoaned the creation of life without sexual intercourse, fearing that in vitro fertilization would degrade human dignity as people became the object of mechanistic creation in glass dishes. The biggest fear was that in vitro fertilization might produce deformed or dead babies. Three decades later, none of those scary predictions have panned out.

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Louise Joy Brown, the first test-tube baby, with her parents in England on Oct. 18, 1979.

Steptoe and Edwards never really clearly explained to the Browns that they had never done in vitro fertilization before — the consent they got was lousy by today’s standards. But they also knew that IVF had worked without any problem in many different types of animals and were confident that the same would prove true in humans.

When Louise Brown was born healthy and intact, that was pretty much the end of the safety concerns about IVF. Like it or not, giving a couple eager to create a family a healthy baby silenced the critics almost instantly. And subsequently there has been no solid evidence of any risk to health associated with in vitro fertilization, as a study released earlier this month at the European Society of Human Reproduction and Embryology found. In fact, any lingering worries about the impact of IVF on Louise Brown were put to rest a year and a half ago when she had her own child, a perfectly healthy boy who was conceived naturally.

The critics also were way off the mark with their fears about stigma and loss of dignity. Do you know which of your friends might have been born using in vitro fertilization? Would you care if you did? Society quickly adapted to the idea of starting fetal life in dishes and there is no more stigma associated with being born by IVF than there is to being born via C-section. Even the Catholic Church, which has never approved the break between sex and procreation, has taken a relatively benign view of the use of IVF by married couples.

The early pioneers never had concerns about how many embryos to put into a uterus: They went in one at a time. But, today, some clinics will implant four, five, six or even more embryos, leading to multiple pregnancies, premature births and all of the problems associated with very low birthweight babies.

And surely it is of ethical concern when people in their 70s use IVF to have babies. Despite all those ads with great-looking 70-somethings playing tennis and dancing aboard cruise ships, a 70-year-old woman giving birth to twins is a super high-risk pregnancy for both mom and the babies, and also a likely route to making orphans.

Even if the babies are born healthy when one or both parents is over 70, are they really in a position to parent kids through their teen years? (Omkari Panwar’s husband, Charam Singh, is even older — he says he’s in his mid-70s.) Shouldn't there be some limit on age that recognizes that kids should have a chance of having at least one parent who is physically capable of raising them?

But age isn’t the only ethical issue in this case, and probably won’t be the most important factor in the future. The Indian couple with the newborn twins already had female children and grandchildren. But they wanted a boy.

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Louise Brown, then and now.

The question here is whether that’s a good enough reason for doctors to try IVF in a septegenarian: to accommodate cultural bias that sons are better than daughters. Given the risks and the costs involved, I doubt it.

Lots of people have all sorts of reasons for wanting babies using IVF. Some seek to sort out their embryos to avoid passing on terrible diseases. Some know their biological clock is ticking and want a baby, with or without a dad around. And some want to use IVF so they can get the sex or traits in a child that they prefer.

No one thought of these sorts of scenarios when IVF produced Louise Brown 30 years ago. Then doctors were struggling to help the infertile have children. They didn’t imagine treating "infertility" in a woman two decades beyond the typical age of menopause. Nor did they imagine using IVF just to get a boy.

Today, doctors must struggle to decide which reasons or preferences of their infertility patients — some who may actually be fertile — they ought to honor. That’s why the future of IVF isn’t really about treating infertility anymore. It’s about designing our descendents.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania